gms | German Medical Science

19. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

30.09. - 01.10.2020, digital

Connecting the dots: impact of interprofessional medication reviews supported by health information technology (HIT) on medication appropriateness

Meeting Abstract

  • Johanna Dellinger - Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
  • Stefan Pitzer - Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
  • Dagmar Schaffler-Schaden - Allgemein-, Familien- und Präventivmedizin, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
  • Magdalena Schreier - Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
  • Laura Fährmann - Institut für Pharmazeutische und Medizinische Chemie, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
  • Georg Hempel - Institut für Pharmazeutische und Medizinische Chemie, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
  • Rudolf Likar - Abteilung für Anästhesie und Intensivmedizin, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Österreich
  • Jürgen Osterbrink - Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
  • Maria Flamm - Allgemein-, Familien- und Präventivmedizin, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich

19. Deutscher Kongress für Versorgungsforschung (DKVF). sine loco [digital], 30.09.-01.10.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. Doc20dkvf356

doi: 10.3205/20dkvf356, urn:nbn:de:0183-20dkvf3560

Veröffentlicht: 25. September 2020

© 2020 Dellinger et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Background and current (inter)national research: Polypharmacy and inappropriate use of medication is a widespread issue in nursing home residents (NHRs) [1]. Managing medication in NHRs is an interprofessional challenge, which can be exacerbated by gaps in transfer of medication-related information [2]. Health information technology (HIT) has been proposed as a way to bridge these gaps [1], [2].

Research question and objective: An intervention tailored to routine care processes combining educational training, HIT and a therapy check-process to improve cooperation between healthcare professionals was developed. We tested its impact on the appropriateness of medication prescribed to NHRs.

Methods or hypothesis: A non-randomized controlled study was conducted in six nursing homes (NHs) (2016-2018). We assessed medication appropriateness using the Medication Appropriateness Index (MAI), as well as several potential risk factors of inappropriate medication [3]. Data was collected before (t0), during (t1, month 12) and after (t2, month 18) intervention. Descriptive analysis as well as multivariable linear regression were performed. Subgroup analysis was done to examine interventional impact if medication is inappropriate at baseline.

Results: 6 NHs, 17 GPs and 240 NHRs (68.8% female; mean age 85.0) were included. Mean MAI-change was -3.4 (intervention group (IG)) vs. -1.5 (control group (CG)). Cut-off for subgroup analysis was identified as baseline MAI ≥23. In this group, MAI-change was -10.3 (IG) vs. -3.5 (CG). In multivariable regression models, intervention was a significant predictor of improvement in MAI. In the IG, NHRs in the subgroup ≥23 MAI points were significantly younger, with higher cognitive ability and a higher number of medications prescribed than those below cut-off.

Discussion: Mean reduction in IG compared to CG in the whole sample was smaller than hypothesized. Mean improvement observed in CG might be attributed to changes made during routine care. Subgroup analysis showed larger improvement in the IG compared to the CG.

Implications for practice: A tailored HIT intervention was shown to be a feasible approach to improve NHRs’ medication appropriateness. Impact of the intervention was larger in NHRs with comparatively inappropriate medication at baseline.


References

1.
Alldred DP, Kennedy MC, Hughes C, Chen TF, Miller P. Interventions to optimise prescribing for older people in care homes. Cochrane Database Syst Rev. 2016 Feb;2:CD009095. DOI: 10.1002/14651858.CD009095.pub3 Externer Link
2.
McKibbon KA, Lokker C, Handler SM, Dolovich LR, Holbrook AM, O'Reilly D, Tamblyn R, Hemens BJ, Basu R, Troyan S, Roshanov PS. The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. J Am Med Inform Assoc. 2012 Jan-Feb;19(1):22-30. DOI: 10.1136/amiajnl-2011-000304 Externer Link
3.
Nothelle SK, Sharma R, Oakes AH, Jackson M, Segal JB. Determinants of Potentially Inappropriate Medication Use in Long-Term and Acute Care Settings: A Systematic Review. J Am Med Dir Assoc. 2017 Sep;18(9):806.e1-806.e17. DOI: 10.1016/j.jamda.2017.06.005 Externer Link